BACKGROUND Post-colonoscopy diverticulitis is increasingly recognized as a potential complication. However, the evidence is sparse in the literature. AIM To systematically review all available evidence to describe the incidence, clinical course with management and propose a definition. METHODS The databases PubMed, EMBASE and Cochrane databases were searched using with the keywords up to June 2020. Additional manual search was performed and cross-checked for additional references. Data collected included demographics, reason for colonoscopy, time to diagnosis, method of diagnosis (clinical vs imaging) and management outcomes. RESULTS A total of nine studies were included in the final systematic review with a total of 339 cases. The time to diagnosis post-colonoscopy ranged from 2 h to 30 d. Clinical presentation for these patients were non-specific including abdominal pain, nausea/vomiting, per rectal bleeding and chills/fever. Majority of the cases were diagnosed based on computed tomography scan. The management for these patients were similar to the usual patients presenting with diverticulitis where most resolve with non-operative intervention ( i.e. , antibiotics and bowel rest). CONCLUSION The entity of post-colonoscopy diverticulitis remains contentious where there is a wide duration post-procedure included. Regardless of whether this is a true complication post-colonoscopy or a de novo event, early diagnosis is vital to guide appropriate treatment. Further prospective studies especially registries should include this as a complication to try to capture the true incidence.

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On-site wastewater treatment systems (OWTS) are widely used in Western Australia (WA) to treat and dispose of household wastewater in areas where centralized sewerage systems are unavailable. Septic tanks, aerobic treatment units (ATUs), and composting toilets with greywater systems are among the most well established and commonly used OWTS. However, there are concerns that some OWTS installed in WA are either performing below expected standards or failing. Poorly performing OWTS are often attributed to inadequate installation, inadequate maintenance, poor public awareness, insufficient local authority resources, ongoing wastewater management issues, or inadequate adoption of standards, procedures, and guidelines. This paper is to review the installations and failures of OWTS in WA. Recommendations to the Department of Health Western Australia (DOHWA) and Local Government (LG) in regard to management strategies and institutional arrangements of OWTS are also highlighted.

BackgroundWell-known trauma mortality prediction scores such as New Injury Severity Score (NISS), Revised Trauma Score (RTS), and Trauma and Injury Severity Score (TRISS) have been externally validated from high-income countries with established trauma databases. However, these scores were never used in Malaysian population. In this current study, we attempted to validate these scoring systems using our regional trauma surgery database.MethodsA retrospective analysis of the regional Malaysian Trauma Surgery Database was performed over a period of 3 years from May 2011 to April 2014. NISS, RTS, Major Trauma Outcome Study (MTOS)-TRISS, and National Trauma Database (NTrD)-TRISS scores were recorded and calculated. Individual scoring system’s performance in predicting trauma mortality was compared by calculating the area under the receiver operating characteristic (AUC) curve. Youden index and associated optimal cutoff values for each scoring system was calculated to predict mortality. The corresponding positive predictive value, negative predictive value, and accuracy of the cutoff values were calculated.ResultsA total of 2208 trauma patients (2004 blunt and 204 penetrating injuries) with mean age of 36 (SD = 16) years were included. There were 239 deaths with a corresponding mortality rate of 10.8%. The AUC calculated for the NISS, RTS, MTOS-TRISS, and NTrD-TRISS were 0.878, 0.802, 0.812, and 0.848, respectively. The NISS score with a cutoff value of 24, sensitivity of 86.6% and specificity of 74.3%, outperformed the rest (p < 0.001). Mortality was predicted by NISS with an overall accuracy of 75.6%; its positive predictive value was at 29.02% and negative predictive value at 97.86%.ConclusionAmongst the four scores, the NISS score is the best trauma mortality prediction model suited for a local Malaysian trauma population. Further validation with multicentre data in the country may require to ascertain the finding.